A Case of Delayed Penetration of the Esophagus after Mesh Repair for Esophageal Hiatal Hernia Treated with Double Tract Reconstruction

An 80-year-old woman underwent laparoscopic Toupet fundoplication and mesh repair for esophageal hiatal hernia. Stenosis of the esophagogastric junction appeared postoperatively, and balloon dilatation was repeated. Subsequent upper gastrointestinal endoscopy revealed mesh penetration into the abdominal esophageal lumen. The patient was referred to our department for treatment and surgery was performed. The area around the hiatus of the esophagus was tightly scarred, and the mesh penetrated the right side of the esophagus. The mesh was removed from the diaphragm, and the penetrated lesion was excised including the gastric cardia side and the lower esophagus. Reconstruction was performed using the double-tract method, and the dilated esophageal hiatus was covered with the remnant stomach. The use of mesh in esophageal hiatal hernia has been reported to lead to complications, such as stenosis and penetration. In this case, we performed lower esophagectomy and proximal gastrectomy with double-tract reconstruction for esophageal penetration. This technique is useful because it avoids anastomosis at the scar lesion of the esophagus and can allow closure of the esophageal hiatus with the remnant stomach.